MD vs Machine: 2 ECG Challenges
Computer-interpreted ECGs are part of SOP -- but the interpretation still needs confirmatin. See if your ECG read matches the machine in 2 cases from the ED.
Computerized interpretation of the electrocardiogram (CIE) was introduced to improve correct ECG interpretation, facilitate healthcare decision making, and potentially reduce costs. CIE is used worldwide but CIE over-reading/confirmation by an experienced ECG reader is essential and widely recommended in the literature. Two cases of CIE in the emergency department follow in a short MD vs Machine challenge.
Case #1. The 52-yo man has no medical history other than insomnia. Do you agree with the CIE?
Case #2. The 82-yo woman is observed to be in respiratory distress but denies any symptoms. Another CIE read. Your thoughts? (Links to original full cases are provided at the end of this slide show.)
Palpitations and Insomnia in Middle Age. A 52-year-old man with a history of insomnia but no other medical problems presents to the ED after experiencing 4 days of intermittent palpitations. Vital signs and PE are normal.
Computer ECG interpretation: “Sinus rhythm with frequent premature ventricular complexes in a pattern of bigeminy.” Do you agree?
Computer ECG interpretation is inaccurate. The actual rhythm is atrial bigeminy with alternating aberrancy. The PACs have multiform aberrancy with one form being far wider (actually in a left bundle branch block pattern) than the other. This is a very unusual dysrhythmia. Conclusion: After 24 hours without further dysrhythmias, he was cleared by cardiology for discharge to home.
Hypoxia in an Elder. An 82-year-old woman is sent to the ED for hypoxia; she has no history of pulmonary disease. She was lately observed to be hypoxic and slightly febrile and was started on antibiotics. Sudden respiratory distress (SaO2, 74% on room air) brings her to the ED.
Vital signs and physical examination. Notable for moderate respiratory distress with bilateral wheezing, prolonged expirations, bilateral rales; peripheral edema and disuse atrophy in both legs. Differential diagnosis: Dysrhythmia, congestive heart failure, COPD, pneumonia, pulmonary embolism.
Computer ECG interpretation: “Normal sinus rhythm, inferior ischemia, possibly acute.” Do you agree?
Computer ECG interpretation is accurate. Tracing does show deep T-wave inversion in 2 of 3 inferior leads, which is consistent with ischemia--but is not specific for cardiac ischemia. Also seen is borderline elevated pulse at 96 beats/min with an S1Q3T3 pattern (S wave in lead 1 and Q and T waves in lead 3).
Case conclusion: The patient was treated for CHF, related bronchospasm, and possible pneumonia. She was evaluated for PE. DUS of the legs was positive so heparin was started; TPA was considered but not given as vital signs were improving. She was admitted to ICU with plan for scan or CT angiography of the chest once her renal function improved (creatinine was acutely elevated).
For additional details and discussion on each case, please see the original postings:
